Portable neuroimaging differentiates novices from those with experience for the Fundamentals of Laparoscopic Surgery (FLS) suturing with intracorporeal knot tying task.

BACKGROUND: The goal of this study was to compare the brain activation patterns of experienced and novice individuals when performing the Fundamentals of Laparoscopic Surgery (FLS) suture with intracorporeal knot tying task, which requires bimanual motor control.

METHODS: Twelve experienced and fourteen novice participants completed this cross-sectional observational study. Participants performed three repetitions of the FLS suture with intracorporeal knot tying task in a standard box trainer. Functional near infrared spectroscopy (fNIRS) data was recorded using an optode montage that covered the prefrontal and sensorimotor brain areas throughout the task. Data processing was conducted using the HOMER3 and AtlasViewer toolboxes to determine the oxy-hemoglobin (HbO) and deoxyhemoglobin (HbR) concentrations. The hemodynamic response function based on HbO changes during the task relative to the resting state was averaged for each repetition and by participant. Group-level differences were evaluated using a general linear model of the HbO changes with significance set at p < 0.05.

RESULTS: The average performance score for the experienced group was significantly higher than the novice group (p < 0.01). There were significant cortical activations (p < 0.05) in the prefrontal and sensorimotor areas for the experienced and novice groups. Areas of statistically significant differences in activation included the right dorsolateral prefrontal cortex (PFC), the right precentral gyrus, and the right postcentral gyrus.

CONCLUSIONS: Portable neuroimaging allowed for the differentiation of brain regions activated by experienced and novice participants for a complex surgical motor task. This information can be used to support the objective evaluation of expertise during surgical skills training and assessment.